Theories, Models, Framework

- Addresses the concepts, definition and

interrelationships of nursing and healthcare
informatics
INFORMATICS – is a science that combines a domain
science, computer science, information science and
cognitive science
HEALTH INFORMATICS – integration of health science,
computer science, information science and cognitive science
– is related to the processing of data of patients records into SCHIWIRIAN’S MODEL (1986)
information which is supported by information systems
 nursing informatics involves identification of
- Addresses the study and management of healthcare information needs, resolution of the needs, and
information attainment of nursing goals/objectives.
Nursing Informatics – subdomain of healthcare  Patricia Schwirian proposed a model intended to
informatics, shares common areas of science with other stimulate and guide systematic research in nursing
subdomain informatics, model/framework that enables
identification of significant information needs, that
- Nurses work both collaboratively with other healthcare can foster research (somewhat similar to Maslow’s
disciplines and independently when engaged in clinical hierarchy of needs).
nursing practice
- ANA, 1995 – Nursing Informatics is the specialty that
integrates nursing science, computer science and
information science

Nursing Informatics Models

1. Graves and Corcoran’s Model
2. Schiwirian’s Model
3. Turley’s Model
TURLEY’S MODEL (1996) -nursing informatics is the
4. Data Information Knowledge (D-I-K) Model intersection between the discipline-specific science
(nursing) and the area of informatics.
5. Benner’s Novice to expert Model

3 core components of informatics

Specific Informatics Models
- Cognitive science
1. Philippine Healthcare Ecosystem Model
- Information science
2. Shift Left Model
- Computer science.
3. PATIENT MEDICAL RECORD INFORMATION
MODEL (PMRI)

Graves and Corcoran’s Model (1989)

- Nursing Informatics as the linear progression from data
into information and knowledge
- Management Processing is integrated within each
elements, depicting nursing informatics as the proper
management of knowledge – from data as it is converted
into information and knowledge
DATA-INFORMATION- KNOWLEDGE MODEL
•NI is a specialty that integrates nursing science, computer
science and information science to manage and
communicate data, information, knowledge and wisdom into
nursing practice (ANA).
•NI is an evolving, dynamic process involving the
conversion of data into information, subsequently
knowledge.
DATA-INFORMATION- KNOWLEDGE MODEL
BENNER’S LEVEL OF EXPERTISE MODEL
every nurse must be able to continuously exhibit the
capability to acquire skills (in this case, computer literacy
skills parallel with nursing knowledge), and then
demonstrate specific skills beginning with the very first
student experience.
According BERNER, there are 5 levels of expertise:
knowledge.
BENNER’S LEVEL OF EXPERTISE MODEL
Specific Informatics Models
Nursing informatics is a huge network that encompasses all
the sectors of the health care delivery system – government
agencies, health care facilities, practitioners, insurance
companies, pharmaceutical companies, academic
institutions, and suppliers the government, different nursing
associations and developmental agencies maintain and
balance the network
2. INTEL’S SHIFT LEFT MODEL
care shifts/progresses from a high quality delivery of life
through technology with increased costs (right side) into
quality of life with minimal health costs .
Inverse relationship between quality of life and cost of
care/day
3.PATIENT MEDICAL RECORD INFORMATION
MODEL (PMRI):
BASIS OF EHR
The type and pattern of documentation in the patient record
will be dependent on 3 interacting dimensions of health
care:
1. Personal health dimension – personal health record
maintained and controlled by the individual or family;
nonclinical information e.g. self-care trackers,
directories of health care, and other supports
2. Health care provider dimension – promotes quality
patient care, access to complete accurate patient data
24/7 e.g. provider’s notes/prescription, clinical orders
decision support systems, practice guideline
3. Population health dimension – information on the
health of the population and the influences to health;
helps stakeholders identify and track health threats,
assess population health, create and monitor programs
and services, and conduct research
Important Terminologies (Data Sets)
1. ABC codes The nursing shortage
2. Perioperative Nursing Data Set (PNDS)
3. SNOMED CT Three primary factors are contributing to the current
4. International Classification for Nursing Practice shortage
(ICNP) including:
5. Patient Care Data Set (PCDS)
6. NANDA - Steep population growth and an aging population
which are increasing the need for health care services
- A diminishing pipeline of new students in nursing
ABC CODES
- An aging nursing workforce
1. mechanism for coding integrative health
2. interventions by clinician for
3. administrative billing and insurance
4. claims Increased demand for patient safety
5. includes complementary and alternative
 Patient safety is an international issue.
6. medicine interventions and codes that
7. map all NIC, CCC, and Omaha system  Standards focusing on the patient well being cut
8. interventions across all models of care, categories of disease and
health conditions and all types of providers. Part of
the challenge if measuring outcomes rest in
defining what outcome really is.
Perioperative Nursing Data Set (PNDS)  They could relate to individual patient across
several encounters or they might measure a system.
• universal language for perioperative nursing practice and
education; Outcome measurement can relate to any of the following
areas:
• standardize documentation of perioperative data in all
perioperative settings 1. Organizational performance
2. Clinical effectiveness
• Diagnosis based on NANDA, interventions based on NIC,
3. Patient satisfaction
and outcomes based on NOC
4. Service quality
5. Appropriateness of care
6. Patient responses to treatments
SNOMED CT (Systematized Nomenclature of Medicine 7. Cost of services
Clinical Terms 8. Efficiency of services delivered
• core clinical terminology containing over 357,000 The need for visibility
healthcare concepts with unique meanings and formal logic-
based definitions organized into multiple hierarchies In the world of prove-it healthcare, if it is not documented, it
was not done. If nursing cannot establish its contributions to
patient outcomes, nursing becomes invisible and in fiscally
tightened market, invisibility can mean expendability.
International Classification for Nursing Practice (ICNP)
Nursing must have a way to substantiate its role in
• integrated terminology for nursing practice developed healthcare process and its vitality outcomes.
under sponsorship of ICN
Nursing management administrative needs
• ICNP elements:
The rapid proliferation of nursing information systems
o Nursing phenomena (nursing diagnosis) compels nursing to face the vast challenge to learn and
working within the age of technology. IT influences the
o Nursing actions (nursing interventions) manner in which practice, how they are educated and the
methods of providing and documenting patient care.
o Nursing outcomes
Two level of nursing administrator:
Nursing Informatics: 3rd Year, 1st Sem, Midterms
1. Nurse manager
Administrative Application of Information Technology for 2. Nurse executive
Nursing Managers
Application and Implication of Information Technology
Three major issues have an administrative impact on the for Nursing management
workplace, the profession, and the future of nursing
managers and administrators Nursing information system- A software system that
automates the nursing process from assessment to
 The Nursing Shortage evaluation, including patient care documentation.
 Increased Demand for patient safety
 The need for visibility - It also includes a means to manage the data necessary for
the delivery of patient care
The Real cost of administrative system What Nursing Administrator Need to know about Selecting
a System
To determine the true cost of automation, one must take
three things into account: 1. The system must include the following:
2. Networkwide information access
1. Cost of hardware and software 3. Networkwide master patient index
2. Cost of education 4. User-friendly system interface
3. Intellectual resources 5. Interface engines for system communications
6. Data repositories to facilitate data sharing
7. Specialized manage care software
The Need for Nursing Data Standards 8. Standards
9. Systems for data comparison
Several years after developing practice standards, ANA 10. Software for longitudinal patient records
establish the Nursing Information and Data Set Evaluation 11. Standardization on a limited number of application
Center (NIDSEC) to create and disseminate standards for vendors
information system.
How Nursing Benefits from Information Technology Nursing Administration’s role in IT implementation
1. Strategic Nursing responsibility is to make sure that organizations
2. Tactical understand the value of these system and despite what
3. Operational organizations may say about nursing systems, they can and
do have value in the new healthcare equation According to
In General they help nursing:
the TIME's website "the Philippines is the most storm-
1. Improve communication exposed country." the Philippines is the most exposed
2. Improve order entry country in the world to tropical storms. With more than
3. Improve continuity of care 7,000 islands, the coastline is vulnerable to storm surges.
4. Spend more time on patient care
Informatics
5. Guide critical thinking
6. Tap into expert resources  contribute to increasing the efficiency in disaster
7. Evaluate care response as well as providing a tele-presence for
Specific Computer Applications for Nursing Administrators remote medical caregivers.
and Managers  is not only used in hospital but also in disaster
response. It can be used in tracking victims.
Nurse Managers’ Data Needs

 Allocating available resources to provide efficient

and effective nursing care and implementing
clinical nursing services
 Providing input into executive-level decisions and
collaborating with the nurse executive and others
 Planning, organizing, implementing and controlling
the of individuals and aggregates across the
spectrum of healthcare settings
 Managing organized nursing services and the
environment in which clinical nursing is practice
 Ensuring that standards of nursing practice are
established and implemented and are consistent
with standards of professional organization and
regulatory agencies
 Evaluating care delivery models and of services
provided to individuals and aggregates
Evidence-Based Nursing
Is the process by which nurses make clinical decisions using
the best available research evidence, their clinical expertise
and their patient preferences.
Three areas of research competence are:
1. Interpreting and using research,
2. Evaluating practice and
3. Conducting research
Health care consumers contribute to surveillance
activities
- Now more than ever before consumers have the
opportunity to contribute to surveillance activities
- Some cases, the participation is a conscious
decision in others consumers may be unknowingly
contributing to this informatics process.
Electronic health records, supply inventory and surveillance
of threat detection. also, it helps in informing the volunteers
about the plans and reports.
1. Importance of Active Surveillance During a
Disaster
2. Complement to regular reporting mechanisms
3. Rapidly detect outbreaks and define health
problems
4. Identify groups at risks for adverse health events
5. Determine needs of special populations

Use of Informatics in Disasters
- Real-time and accurate epidemiologic data is
critical to decision making
- Delivery of appropriate public health services
during emergency events such as disease outbreaks
or disasters is essential.
- Agencies must receive data from the field quickly
and have the ability to compare results across
jurisdictions when multiple states are affected.
Quick response from the agency will:
1. Optimize the relief response
2. Monitor the effectiveness of the relief effort
3. Respond to public concerns and media inquiries
4. Facilitate planning for future disasters
HRSA - Health Resource and Services Administration is
an agency of the U.S. Department of Health & Human
Services (HHS), provides health care to people who are
geographically isolated, and/or economically or medically
vulnerable. This includes people living with HIV/AIDS,
pregnant women, mothers and their families, and those
otherwise unable to access high quality health care.
supports the training of health professionals, the distribution
of providers to areas where they are needed most, and
improvements in health care delivery. In addition, HRSA
oversees organ, bone marrow, & cord blood donation. It
compensates individuals harmed by vaccination, and
maintains databases that flag providers with a record of
health care malpractice, waste, fraud, and abuse for federal,
state and local use.

Informatics Solutions:
Healthcare members develop a bar code system to log and
track victims
Three Units Focusing on Emergency Planning and Response
1. CDC- Centers for Disease Control & Prevention
2. AHRQ- Agency for Healthcare Research and
Quality
3. HRSA- Health Resource and Services
Administration

CDC - Centers for Disease Control & Prevention. works

24/7 to protect America from health, safety and security
threats, both foreign and in the U.S. Whether diseases start
at home or abroad, are chronic or acute, curable or
preventable, human error or deliberate attack, CDC fights
disease and supports communities and citizens to do the
same.
increases the health security of our nation. As the nation's
health protection agency, CDC saves lives and protects
people from health threats. To accomplish our mission, CDC
conducts critical science and provides health information
that protects our nation against expensive and dangerous
health threats, and responds when these arise.

AHRQ - Agency for Healthcare Research and Quality

- It is the lead Federal agency charged with improving the
safety and quality of America's health care system. AHRQ
develops the knowledge, tools, and data needed to improve
the health care system and help Americans, health care
professionals, and policymakers make informed health
decisions
- Agency for Healthcare Research and Quality mission: to
produce evidence to make health care safer, higher quality,
more accessible, equitable, and affordable, and to work
within the U.S. Department of Health and Human Services
and with other partners to make sure that the evidence is
understood and used.